Nursing Elites

1. A client with congestive heart failure taking digoxin reports nausea and refuses to eat breakfast. Which action should the nurse take first?

• A. Encourage the client to eat the toast on the breakfast tray.
• B. Administer an antiemetic.
• C. Inform the client's provider.
• D. Check the client's apical pulse.

Correct answer: D

Rationale: The correct action for the nurse to take first is to check the client's apical pulse. Nausea can be a sign of digoxin toxicity, and one of the early signs of digoxin toxicity is changes in the pulse rate. By checking the client's apical pulse, the nurse can assess if the digoxin level is too high. Encouraging the client to eat or administering an antiemetic may not address the underlying issue of digoxin toxicity. While informing the provider is important, assessing the client's condition through checking the apical pulse should be the immediate priority.

2. A nurse is providing teaching to a newly licensed nurse about administering morphine via IV bolus to a client. Which of the following information should the nurse include in the teaching?

• A. Respiratory depression can occur within 7 minutes after the morphine is administered.
• B. The morphine will peak within a few minutes.
• C. Withhold the morphine if the client has a respiratory rate less than 16/min.
• D. Administer the morphine over 2 minutes.

Correct answer: A

Rationale: The correct answer is A because respiratory depression is a significant risk when administering morphine, and it can occur within 7 minutes after administration. This information is crucial for the nurse to recognize and respond promptly. Choice B is incorrect because the peak effect of morphine via IV bolus is typically reached within a few minutes, not specifically 10 minutes. Choice C is incorrect because withholding morphine based solely on a respiratory rate less than 16/min may not be appropriate without considering other factors such as pain level, oxygen saturation, and overall respiratory status. Choice D is incorrect because administering morphine over 2 minutes may not prevent respiratory depression if it occurs rapidly after administration. Nurses should be vigilant for signs of respiratory depression regardless of the administration duration.

3. A nurse is providing teaching to a client who has cirrhosis and a new prescription for lactulose. The nurse should instruct the client that lactulose has which of the following therapeutic effects?

• A. Increases blood pressure
• B. Prevents esophageal bleeding
• C. Decreases heart rate
• D. Reduces ammonia levels

Correct answer: D

Rationale: The correct answer is D: Reduces ammonia levels. Lactulose is used to reduce blood ammonia levels in clients with hepatic encephalopathy. Options A, B, and C are incorrect because lactulose does not have the therapeutic effect of increasing blood pressure, preventing esophageal bleeding, or decreasing heart rate.

4. A client at 28 weeks of gestation is experiencing preterm labor. Which of the following medications should the nurse plan to administer?

• A. Oxytocin
• B. Nifedipine
• C. Dinoprostone
• D. Misoprostol

Correct answer: B

Rationale: Nifedipine is the correct choice because it is a calcium channel blocker that helps relax the uterus and stop preterm labor. Oxytocin (Choice A) is used to induce labor, not to stop preterm labor. Dinoprostone (Choice C) and Misoprostol (Choice D) are prostaglandins used to induce labor and ripen the cervix, not to stop preterm labor.

5. A client with chronic kidney failure and an AV fistula for hemodialysis is prescribed epoetin alfa. Which of the following therapeutic effects should the nurse include in the teaching?

• A. Reduces blood pressure
• B. Inhibits clotting of fistula
• C. Promotes RBC production
• D. Stimulates growth of neutrophils

Correct answer: C

Rationale: The correct answer is C: Promotes RBC production. Epoetin alfa stimulates erythropoiesis (red blood cell production) to treat anemia associated with chronic kidney failure. This helps in increasing the hemoglobin levels and improving oxygen-carrying capacity. Choices A, B, and D are incorrect as epoetin alfa does not have direct effects on reducing blood pressure, inhibiting clotting of the fistula, or stimulating the growth of neutrophils.

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